Assisted Suicide

[mgriffiths]

From my perspective a crazy story...I'll just leave it at that, and I hope I'm not setting up for a nasty discussion as this is a major philosophical and political discussion akin to abortion discussions.  Mods do as you will, but I hope we can have a civil discussion regarding the spreading concept of euthanasia.

 

https://www.foxnews.com/world/dutch-rape-victim-euthanasia

Dutch rape victim, 17, uses legal euthanasia to end life

A 17-year-old girl who wrote a book about her struggle with mental illness after being molested and raped has been euthanized in the Netherlands, where she lived and assisted-suicide is legal.

Reports say Noa Pothoven chose to end her life Sunday with the assistance of an end of life clinic, Inside Edition reported.

Under Netherlands law, a doctor has to sign off on the decision after concluding that the patient’s suffering is unbearable and likely to continue, the news outlet reported.

“I deliberated for quite a while whether or not I should share this, but decided to do it anyway,” she wrote on Instagram on the day before her death, according to Inside Edition. “Maybe this comes as a surprise to some, given my posts about hospitalization, but my plan has been there for a long time and is not impulsive.”

Noa said she had been fighting for years and was now “drained,” and that she felt she had never been alive but was instead just “surviving.”

“I have quit eating and drinking for a while now, and after many discussions and evaluations, it was decided to let me go because my suffering is unbearable,” Pothoven wrote, according to Inside Edition. “Love is letting go, in this case.”

The teen from Amhem suffered from post-traumatic stress disorder, depression and anorexia after being molested when she was 11 and 12 and raped by two men when she was 14, The Sun reported.

She reported the attacks to police last year.

Noa wrote about her struggles in “Winning and Learning.”

Her mother, according to Dutch law, had a say in her daughter’s decision, according to The Sun.

Edited June 4, 2019 by mgriffiths

[Cideous]

I read that this morning as well.  Pretty grey there.  I get terminal illness etc but this is a little tougher for me to swallow.

[LKPAC]

At age 17, you don't realize that life gets better.  Too bad she couldn't get the help she really needed.

[mgriffiths]

28 minutes ago, LKPAC said:

At age 17, you don't realize that life gets better.  Too bad she couldn't get the help she really needed.

This...and the fact that a doctor signed off and mother agreed is astounding.  Especially given that they are completely ignoring that teenage years are majorly difficult for obvious developmental reasons...plus sounds like the girl had a relatively "major" online presence which is continuously being shown to increase risks of depression, anxiety, etc.

 

I don't personally agree with euthanasia, but I find this very sad.

[ventana]

Some generalizations i have had over the years - (I have been asked by a number of patients to facilitate their passing and it was always and immediate no that is illegal answer)

 

We keep patients alive by interventions, medications, procedures - we play god already

I believe there is a difference with stopping treatments and I would not consider this assisted suicide - this is just no longer interfering with the natural course

I used to be unsure about assisted suicide.  Recently however I have come to believe this should only be done by providers with very specific training and with some type of oversight.  Think radiation for CA treatment - not every PA/NP/MD/DO can order this and there is a a large oversight component that has to be satisfied

 

I personally have decided I would never want taking a life on my own soul.  I can allow mother nature to takes it course and not provide life sustaining treatment, but I could not take someone's life purposefully with my medical knowledge.  

 

I honestly do not know where society should stand on this issue and would defer to the medical ethics experts to help guide out laws.  I am however fearful that only a few sides of this highly complex and very difficult topic are being utilized - i.e. religion and ethics.... 

 

 

I can only say I could never do it, but I can not speak for others.

[mgriffiths]

26 minutes ago, ventana said:

I am however fearful that only a few sides of this highly complex and very difficult topic are being utilized - i.e. religion and ethics....

Absolutely true, and I will readily admit that my religious beliefs STRONGLY factor into my "feelings" about this topic...as well as a bunch of others of course.

[jmj11]

Here is where I'm perplexed. The Dutch are civilized with advance medical care. There are so many options in treating depression, I just cannot believe all those options were exhausted. I read a previous debate (in a BBC report I think, but see the report belowhttps://www.vice.com/en_us/article/434yaj/a-doctor-built-a-machine-that-helps-people-die) were a proponent of assisted suicide decided that depression, at any age, was reasonable for suicide. In a pure Darwinist (the way I use the term here would upset Darwin himself) view, you might reach that conclusion. But has compassionate care givers, we must always give hope. I was distressed when I was in ICU in January,  just diagnosed with cancer, and a new-grad RN said to me, after I mentioned this long-hard road ahead, and she said, "Well, you are 63. Some people in your position would say that you have lived enough and to save the money and suffering, they would end their life now). I asked her, "Can't anyone talk of hope?"

[Cideous]

We had a VERY long Euthanasia thread here I think late last year.  Lots of good opinions and insight.  I encourage anyone interested to search for it.

[SHU-CH]

46 minutes ago, jmj11 said:

 and a new-grad RN said to me, after I mentioned this long-hard road ahead, and she said, "Well, you are 63. Some people in your position would say that you have lived enough and to save the money and suffering, they would end their life now). 

[Zach]

Just to provide a foil, I found this thread from David Juurlink awfully compelling: link.

"I’m no MAiD expert, and I get that some people are opposed to it for various reasons. But I’ve been a doctor for 25 years, and I’ve seen enough deaths to know a good one from a bad one.

This was, without exaggeration, the best death I have ever witnessed."

I think there is something to be said for getting to die on your own terms. 

Edited June 5, 2019 by Zach

[rev ronin]

I agree with @SHU-CH--that's a mind-numbingly insensitive thing for a caregiver to suggest.  Killing people to save money is the job of insurance companies, not nurses.

In all seriousness, the fundamental, inescapable problem with provider-supported suicide is economic justice: the rich get whatever they want and can afford, the poor get told they need to take a long walk off a short pier to avoid bankrupting their soon-to-be survivors.  I can think of few more intolerable injustices on the basis of economic standing, and I'm generally a pretty free market kind of guy.

[rev ronin]

3 minutes ago, Zach said:

I think there is something to be said for getting to die on your own terms. 

Sure, but when your medical provider is beholden to the insurance company and gets indirect benefits from helping as many terminal patients die vs. fight as possible, that's a fundamental conflict of interest.  If society must have arbiters of elective homicide, let it be a separate profession unconnected to medicine; they can do capital punishment cases, too.  The Hippocratic oath exists for a reason, and everything available in modern medicine makes that oath that much more important that it ever has been before.

[Zach]

11 minutes ago, rev ronin said:

Sure, but when your medical provider is beholden to the insurance company and gets indirect benefits from helping as many terminal patients die vs. fight as possible, that's a fundamental conflict of interest.  If society must have arbiters of elective homicide, let it be a separate profession unconnected to medicine; they can do capital punishment cases, too.  The Hippocratic oath exists for a reason, and everything available in modern medicine makes that oath that much more important that it ever has been before.

I think your personal opinions are coloring your professional opinion - even if you do present it as an issue of socioeconomic justice. You have a degree in religion I believe (I have one too so I do not say that in a pejorative way) so I don't think we need to rehash the concepts of negative versus positive rights/means/etc. We already do have arbiters of elective homicide and quite frankly I'm not a fan of those decisions being in their hands... was it not the supreme court that just overruled an appeal from a death row inmate with cavernous hemangioma who wanted an alternative form of execution to avoid choking on his own blood as his tumors ruptured? Certainly sounds cruel and unusual to me... I think these decisions should sit firmly in the hands of medicine and the many people who sit on hospital ethics boards. We do not need to continue ceding things that should fall in our wheelhouse (and I saw "our" to mean those who are specially trained in doing things like this). 

As you present it, the entirety of medicine is a fundamental conflict of interest then. We are paid for our services, and for our recommendations. Surgery walking into a patient's room and selling them on a procedure they don't need is a conflict of interest... ordering a mammogram inpatient as opposed to waiting 5 more days for it outpatient is a conflict of interest... If you want to overhaul the entire system, let's. But I get hints from people in this thread that there's a selective affinity for which hill we are choosing to die on.

Edited June 5, 2019 by Zach

[rev ronin]

2 minutes ago, Zach said:

I think your personal opinions are coloring your professional opinion - even if you do present it as an issue of socioeconomic justice. You have a degree in religion I believe (I have one too so I do not say that in a pejorative way) so I don't think we need to rehash the concepts of negative versus positive rights/means/etc. [...]

As you present it, the entirety of medicine is a fundamental conflict of interest then. We are paid for our services, and for our recommendations. Surgery walking into a patient's room and selling them on a procedure they don't need is a conflict of interest... ordering a mammogram inpatient as opposed to waiting 5 more days for it outpatient is a conflict of interest... If you want to overhaul the entire system, let's. But I get hints from people in this thread that there's a selective affinity for which hill we are choosing to die on.

The problem isn't that I have a background in religion, it's that so few other medical providers do.  It needn't actually be any particular sort of religion, any philosophy or ethics background will do, but when we play with life or death, we need to be thinking much more broadly than our case, our patient, our country.  The People's Republic of China is killing prisoners, most likely prisoners of conscience from Muslim and Tibetan minorities, and harvesting their organs for profit. https://nypost.com/2019/06/01/chinese-dissidents-are-being-executed-for-their-organs-former-hospital-worker-says/

https://www.theguardian.com/science/2019/feb/06/call-for-retraction-of-400-scientific-papers-amid-fears-organs-came-from-chinese-prisoners

Honestly, my consideration of consequences comes more from my studies in game theory and complex adaptive systems than it does from my theology studies.  Not to put too fine a point on it, but philosophy or theology will tell you THAT killing people is bad, but game theory and complexity theory will lead you to think up HOW it's actually going to end badly.

 

I don't disagree with you at all about third party payment being a fundamental conflict of interest.  I would very much love to find a way--widespread and sustainable--to keep the benefits of modern medicine without the downsides that corporatization has given us!  I don't know that zDogg has all the right answers, but he certainly seems to be asking the right questions.

[Guest ERCat]

I am in shock reading that article. In shock. I have never believed that physician assisted suicide is okay, because it literally involves someone "playing God." Stop treatment if the patient wants, and do not resuscitate. But it is not a physician's job to end someone's life. I understand why someone might consider this if they had a terminal illness, but depression? In a SEVENTEEN year old girl? Her brain has not even been fully formed yet - how can she make a decision that she wants her life to be over? Not to minimalize her trauma because it sounds terrible, but many teenagers go through issues with anxiety and depression and we often grow out of it after we gain more experience, confidence, and wisdom. How a doctor could assist in killing a child because she's depressed, rather than actually help her with that depression, is beyond me. How a parent could consent to this...is disgusting. This is absolutely disgusting and horrifying to me. I feel bad for the girl, along with the system (and parents) that completely failed her.

[TWR]

Devil's advocate here.  What is hospice care actually?   What determines palliative vs aggressive treatment>  I actually heard an oncologist ask the age of a patient to determine palliative vs aggressive treat based on age!!!   God???

[sas5814]

 Killing people to save money is the job of insurance companies, not nurses.

 

I don't think a 3rd party, much less a health care provider, should be suggesting death as a cost cutting measure. In a long conversation with one of my oldest and dearest friends who was 4 years into a tough tough fight with prostate cancer we discussed this very thing. he said, and I have pondered this myself, the worry of bankrupting his family and leaving them destitute after his death was one of the concerns and considerations he had when trying to decide what to do and for how long. I know that leads into a whole different conversation about the costs of health care but for now I think it would be at least part of someone's thinking when considering possibilities.

[Cideous]

4 hours ago, ERCat said:

I am in shock reading that article. In shock. I have never believed that physician assisted suicide is okay, because it literally involves someone "playing God." Stop treatment if the patient wants, and do not resuscitate. But it is not a physician's job to end someone's life. I understand why someone might consider this if they had a terminal illness, but depression? In a SEVENTEEN year old girl? Her brain has not even been fully formed yet - how can she make a decision that she wants her life to be over? Not to minimalize her trauma because it sounds terrible, but many teenagers go through issues with anxiety and depression and we often grow out of it after we gain more experience, confidence, and wisdom. How a doctor could assist in killing a child because she's depressed, rather than actually help her with that depression, is beyond me. How a parent could consent to this...is disgusting. This is absolutely disgusting and horrifying to me. I feel bad for the girl, along with the system (and parents) that completely failed her.

Sigh....

I wasn't going to bring this up again as we discussed it ad nauseam in last year's euthanasia thread but here we go.

While I agree with you on this particular depression case, saying that we are wrong to "play God" is just flat out wrong.  We play God every day on every intervention in an effort to heal and/or relieve suffering.  While I don't believe for one second that a 17 year old with PTSD/depression meets the threshold of assisted suicide, many situations do.  The case of the girl in California with terminal brain cancer who had to leave the state in an effort to end her suffering on what was a 100% inevitability being just one example.  And her case ended up changing state law.

If someone is going to make an argument against provider assisted suicide for terminal suffering patients, saying we are "playing God" is not a very good one.  We step into the God role every day we write an antibiotic or cut skin in an effort to relieve suffering.

I think providers forget who we are here to serve.  Not your own religious beliefs, but the patient's needs.  Sometimes that means turning up that Morphine drip, something that happens every single day...

Edited June 5, 2019 by Cideous

[rev ronin]

1 hour ago, Cideous said:

I think providers forget who we are here to serve.  Not your own religious beliefs, but the patient's needs.

Absolutely not!  Provider acts are either unethical--it is always wrong to do something you think is wrong, even if you are wrong that it is wrong--or constrained by religious beliefs. Only once there is no malevolent action on the part of the provider can we assess the external goodness of an action.  Now, one can do plenty of things in the course of healing that allow a patient to use his or her free will to go do things that are against a provider's religious beliefs, but that's on them, not the provider.

In my personal case, I ONLY serve my own religious beliefs.  I've never helped a patient, not once since becoming an EMT, where that action wasn't driven by my own personal faith. Your own care is almost certainly driven by your worldview, too, even if you don't call it a religion.

I do absolutely agree that "playing God" is a poor choice of phrase.  Any provider who has any belief at all in one or more supernatural beings with healing powers WANTS to play God to the extent of healing our patients!  The other half of Divine power--killing, rather than healing--is usually what's meant by "playing God", and I think that's a reasonable distinction.  I am happy to be a healer; it's what makes my day.  Offer me the chance to execute a criminal, and I'm going to defer.  For what it's worth, I doubt I would have said that last bit 10 years ago, but I find that the act of healing people for a living has changed my perspective on a lot of things and caused me to reevaluate my own personal ethical stances.

 

[rev ronin]

28 minutes ago, mcclane said:

The original story here seems to be changing quite a bit over time as the inflammatory nature of it is sparking continued investigation and interest. At play, in part, is possibly a translation issue, and intentionally inflammatory phrasing by pseudo-news outlets. It seems likely that neither euthanasia nor physician assisted suicide occurred here. The individual stopped eating and drinking and a decision was made not to pursue force feeding.

Sigh. Shame on us all for taking something on the Internet at face value...

[TWR]

Rev, You had me up until the last couple of sentences on your post.  (About criminals)  Just my opinion.

[rev ronin]

12 minutes ago, TWR said:

Rev, You had me up until the last couple of sentences on your post.  (About criminals)  Just my opinion.

How are we ever going to teach each other on our respective journeys if we all think alike? Like I said, my own views have changed over the years, so who am I to fault you for seeing things the way I used to? Or any other reasonable way, for that matter?

[sas5814]

We are all the product of our personal experience. I have seen all the evil in the world. I could tell stories many would think I have made up based on an Army career, a law enforcement career, and a medical career. These things color my opinion of the death penalty.

I have seen more people die slow agonizing deaths from horrible diseases, including close family members, that colors my opinion on assisted death.

My much-smarter-than-me wife taught me that "truth" is personal.

[jmj11]

14 hours ago, rev ronin said:

Sure, but when your medical provider is beholden to the insurance company and gets indirect benefits from helping as many terminal patients die vs. fight as possible, that's a fundamental conflict of interest.  If society must have arbiters of elective homicide, let it be a separate profession unconnected to medicine; they can do capital punishment cases, too.  The Hippocratic oath exists for a reason, and everything available in modern medicine makes that oath that much more important that it ever has been before.

Of course advance directives are a good idea. However, the insurance companies are pushing advance directives like crazy. I have been approached over and over about my AD and I do have one on file. But it saves the insurance companies a huge amount of money to end life early. My brother just recovered from MRSA septicemia. It looked bad with him on a vent, doing dialysis and was given up as hopeless. The hospitalist wanted to pull the plug but his oncologist (he has leukemia was in for a stem cell transplant) fought to give him a few more days. He's home and doing well. So, we have to be careful as not to pull the trigger too soon just to save the insurance some money. Thinking of which, I need to call him.

[Guest ral]

The girl chose to stop taking food or fluids, knowing that it would lead to death.  She was not euthanized.  There was just no medical intervention into preventing her from starving to death, at her request.  She was actually denied euthanasia previously.